Pilot Award

Objectives: 1) accurately measure alcohol and drug use, especially amphetamine-type stimulants (ATS) and HIV prevalence, among female sex workers (FSW) and male clients of FSW in Preah Sihanouk Province, Cambodia, and; 2) assess the synergy between alcohol and/or drug exposures and HIV risks according to the type of sex work venues.

Malaria has dominated the illness landscape in sub-Saharan Africa for many decades and fevers in children have typically been treated as malaria without laboratory confirmation. Recently, several parts of Africa have dramatically reduced malaria by employing multiple prevention tools and improving case management. In Zanzibar, 98 out of every 100 hundred febrile patients recently seen in clinics have tested negative for malaria.

Malaria has dominated the illness landscape in sub-Saharan Africa for many decades and fevers in children have typically been treated as malaria without laboratory confirmation. Recently, several parts of Africa have dramatically reduced malaria by employing multiple prevention tools and improving case management. In Zanzibar, 98 out of every 100 hundred febrile patients recently seen in clinics have tested negative for malaria.

Methods to improve accuracy in self-reported sexual behavior are critical in reducing errors that impede accurate assessment of intervention outcomes and prevalence estimates of HIV-related risk. Research findings to date provide abundant empirical evidence that reliability and validity of self-reported sexual behavior is a major problem. Scientific models of the survey question-answer process specify question comprehension as a necessary precursor to enhancing data quality.

Remarkable advances have helped to determine how immune responses act to contain HIV-1 infection, but precise immune correlates of protection still remain largely uncharacterized. The HLA region is a major determinant of genetics linked to viral control. HLA-B*57+ individuals are known to progress slowly to disease, and this allele is overrepresented in elite controllers. My preliminary results show a reduced replicative capacity of HIV-1 in PBMC from seronegative HLA-B*57+ subjects, in comparison to PBMC from subjects carrying HLA-B*35, an allele associated with rapid disease progression.

A key challenge of large-scale intervention trials is to adequately describe the social, cultural and operational factors that influence study findings. Qualitative research methods are particularly useful for elucidating the processes through which such trials may affect primary clinical outcomes through social and behavioral change at the community level. This pilot award would launch the qualitative evaluation of a large "test and treat" intervention, the Sustainable East Africa Research in Community Health (SEARCH) trial.

A key challenge of large-scale intervention trials is to adequately describe the social, cultural and operational factors that influence study findings. Qualitative research methods are particularly useful for elucidating the processes through which such trials may affect primary clinical outcomes through social and behavioral change at the community level. This pilot award would launch the qualitative evaluation of a large "test and treat" intervention, the Sustainable East Africa Research in Community Health (SEARCH) trial.

As the prevalence of metabolic syndrome and obesity rises, and as more effective HCV treatments become available, fatty liver disease will likely become a leading cause of liver disease in persons living with HIV. The purpose of this study is to determine the association of metabolic, host genetic, and viral factors with hepatic steatosis (Aim 1) and hepatic fibrosis (Aim 2) in HIV-infected adults with and without HCV coinfection.

As the prevalence of metabolic syndrome and obesity rises, and as more effective HCV treatments become available, fatty liver disease will likely become a leading cause of liver disease in persons living with HIV. The purpose of this study is to determine the association of metabolic, host genetic, and viral factors with hepatic steatosis (Aim 1) and hepatic fibrosis (Aim 2) in HIV-infected adults with and without HCV coinfection.

This one-year study addresses a neglected topic in HIV research in Africa: the HIV prevention needs of female migrants. The study will address critical gaps in research on methods to obtain valid probability based samples of migrant women and to estimate HIV prevalence in this population at high HIV acquisition and transmission risks. It provides data needed to enhance the study "Identifying Opportunities for HIV Prevention Among Female Migrants in Western Kenya" (K01MH093205-02, Camlin), a qualitative study of factors that facilitate HIV risks among female migrants.